Multiple agencies within the federal government have initiated a broad range of diabetes prevention, detection, and treatment activities. Many state and local agencies have adopted and implemented these activities and programs. Selected examples of these federal efforts are listed below. Web site addresses are provided (where applicable) for more detailed information.

Various agencies within the U.S. Department of Health and Human Services (HHS) have developed health communication campaigns to raise awareness of diabetes and educate patients, providers, employers, and school personnel about how to prevent or delay complications from diabetes.

Steps to a HealthierUS: Putting Prevention First—This program is part of President Bush’s HealthierUS initiative which focuses on preventing chronic diseases and conditions, including obesity, asthma, diabetes, heart disease, stroke, and cancer. It includes funds for innovative community-based programs to address asthma, diabetes, and obesity. The Steps campaign is a bold shift from a disease care system that relies almost exclusively on physician interventions to a health care system where a community-based public health infrastructure supports individuals in making healthy lifestyle choices. More information is available at http://www.healthierus.gov/steps. (See Appendix A)

Initial Preventive Physical Examination and Other New Medicare Benefits—The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 establishes coverage of a one-time “Welcome to Medicare Physical Examination” within 6 months of a beneficiary’s first coverage under Part B, with the goal of health promotion and disease detection. The benefit covers a physical exam (including measurement of height, weight and blood pressure, and an electrocardiogram) and includes education, counseling and referral with respect to screening and other preventive services. The effective date is January 1, 2005, for new beneficiaries whose coverage period under Medicare Part B begins on or after that date. The MMA also adds coverage for cardiovascular and diabetes screening for Medicare beneficiaries, which also begins on January 1, 2005.

Small Steps, Big Rewards: Prevent Type 2 Diabetes—A feature of the National Diabetes Education Program, this educational campaign was introduced in November 2002. The campaign and its multicultural components introduced in 2004, are built on the findings of the Diabetes Prevention Program clinical trial conducted by the National Institute of Diabetes and Digestive and Kidney Diseases. The program Web site provides tool kits and other products intended to motivate people to reduce their risk for type 2 diabetes by losing a modest amount of weight and being more physically active. More information is available at http://www.smallstep.gov/ or http://www.ndep.nih.gov/campaigns/SmallSteps /SmallSteps_index.htm

Weight Control Information Network (WIN)— This network is a national information service of the National Institute of Diabetes and Digestive and Kidney Diseases. WIN develops and distributes science-based materials on obesity, weight control, physical activity, and nutrition for patients, health care professionals, and others in English and Spanish. WIN also created the Sisters Together: Move More, Eat Better media program that encourages Black women 18 and over to maintain a health weight by becoming more physically active and eating healthier foods. More information on WIN is available at http://win.niddk.nih.gov/index.htm.

National Diabetes Information Clearinghouse (NDIC)—The NDIC is an information dissemination service of the National Institute of Diabetes and Digestive Kidney Diseases. The NDIC was established to increase knowledge and understanding about diabetes among patients, health care professionals, and the general public through the effective dissemination of information. Patients and health care providers can contact the NDIC with inquiries about diabetes and order educational material. More information is available at http://diabetes.niddk.nih.gov.

National Agenda for Public Health Action: A National Public Health Initiative on Diabetes and Women’s Health—This initiative offers recommendations to help health professionals, women and their families, health care systems, worksites, communities, and schools address the burden of diabetes among women. The Centers for Disease Control and Prevention is working with public- and private-sector partners to implement the plan. More information is available at http://www.cdc.gov/diabetes/pubs/action/index.htm.

Take Time to Care About Diabetes—This campaign developed by the Food and Drug Administration Office of Women’s Health is intended to raise women’s awareness of the seriousness of diabetes and the importance of taking steps to treat the disease to avoid heart and kidney problems, blindness, stroke, or amputation of a lower limb. More information is available at http://www.fda.gov/womens/taketimetocare/diabetes/default.htm.

Diabetes Today—Developed by the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation, Diabetes Today is a course that provides training for public health professionals and community leaders to learn how to mobilize communities to address diabetes. This curriculum is based on the philosophy that people can take charge of diabetes at the community level. Rather than relying on expensive medical treatment after the complications of diabetes have developed, community members—such as people with diabetes and their families, health professionals, and other concerned individuals—can work together to prevent and control diabetes. For more information, call toll-free 1-877-CDC-DIAB, e-mail diabetes@cdc.gov, or visit the Diabetes Today National Training Center and the Pacific Diabetes Today Resource Center. More information is available at http://www.diabetestodayntc.org/.

Making Systems Change for Better Diabetes Care—As part of National Diabetes Education Program, this comprehensive Web site provides information and tools to make effective systems changes and provide better quality care for the diagnosis, treatment, and prevention of diabetes. More information is available at http://betterdiabetescare.nih.gov/.

Diabetes Prevention Program (DPP)—The Diabetes Prevention Program (DPP) was a multi-center clinical trial led by the National Institute of Diabetes and Digestive and Kidney Diseases at 27 sites around the country. The study demonstrated that sustained lifestyle changes, including modest weight loss and regular physical activity, substantially reduced progression to type 2 diabetes, especially among older adults who were at very high risk. DPP showed that people with pre-diabetes (i.e., elevated blood glucose levels that are not yet high enough to be classified as diabetes) can prevent or delay the onset of type 2 diabetes by losing 5 percent to 7 percent of their body weight and participating in moderate physical activity (e.g., walking 30 minutes per day 5 days per week). Results from DPP were so compelling that the trial was ended a year early. The lifestyle intervention worked equally well for men and women and all racial/ethnic groups, and it was most effective among people aged 60 and older.81

Nutrition and Physical Activity to Prevent Obesity and Other Chronic Diseases program—The Centers for Disease Control and Prevention’s Division of Nutrition and Physical Activity developed this program in response to the growing epidemic of overweight and obesity in the United States. This is a comprehensive program designed to help states maximize the effectiveness of their efforts to prevent obesity by addressing two related risk factors: nutrition and physical activity. The goal of the program is to make the United States a nation where all people can achieve and maintain a healthy body weight. Through a cooperative agreement process, this initiative provides funds to states for up to five years for programs aimed at reducing the rate of obesity among their citizens. More information is available at http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/index.htm.

Diabetesatwork.org—The National Diabetes Education Program’s business and managed care Web site www.diabetesatwork.org is an online diabetes and health resource kit that can help businesses and managed care companies assess the impact of diabetes in the work place. It presents employers with an interactive assessment tool to demonstrate the economics of better diabetes prevention and control guidance for choosing health care plans, and tools for developing worksite interventions and wellness programs. It also provided easy-to-understand information for employers to help employees manage their diabetes and take steps toward reducing the risk for diabetes-related complications such as heart disease. More information can be found at http://wwww.diabetesatwork.org

National Diabetes Prevention Center (NDPC)—This Centers for Disease Control and Prevention funded national center, is working to identify, design, adapt, and share effective programs for diabetes prevention and control in American Indian and Alaskan Native communities. The NDPC supports initiatives in tribal education systems, information technology, diabetes self-management education, sharing diabetes prevention efforts across American Indian and Alaska Native communities, and translating promising practices that are both culturally relevant and science-based. More information is available at http://www.cdc.gov/diabetes/projects/ndpc.htm.

You Can! Campaign—Developed by the Administration on Aging, the You Can!—Steps to a Healthier Aging campaign is a part of the Steps to a HealthierUS initiative. The You Can! campaign is designed to increase the number of older adults who are active and healthy through a partnership approach to mobilizing communities. These community partnerships will increase public awareness and provide appropriate programs to help older Americans improve their nutrition and physical activity.

Health Disparities Collaborative –Diabetes Prevention—The Health Resources and Services Administration, Bureau of Primary Health Care in collaboration with the Centers for Disease Control and Prevention, National Institutes of Health, and other partners, including the Institute for Healthcare Improvement are working to prevent diabetes among high risk individuals served by Federally Funded Health Centers. A Health Disparities Collaborative Diabetes Prevention pilot has been completed with excellent results in patient outcomes. The learning from the Diabetes Prevention collaborative will be integrated with the Cardiovascular Collaborative for improved primary health care in Federally Funded Health Centers. (See Current Activities—Treatment section for additional information on the Health Disparities Collaboratives).

81The Finnish Diabetes Prevention Study conducted by the National Public Health Institute–Helsinki yielded similar findings supporting the importance of maintaining a healthy weight to prevent type 2 diabetes.; and Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. New Eng J Med 346(6):393-403.

Agencies within the U.S. Department of Health and Human Services (HHS) have developed a number of initiatives to promote detection of diabetes in the U.S. Agencies are also conducting research into the most effective strategies for screening pre-diabetes as well as type 2 diabetes.

Diabetes Detection Initiative—This HHS initiative is a community-based effort to identify persons with undiagnosed type 2 diabetes and refer them for follow-up blood testing and treatment, if appropriate. It uses community involvement strategies within health systems in communities throughout HHS regions. It is being pilot tested in 10 locations through 2004. Early diagnosis and proper treatment of diabetes can prevent or delay serious diabetes-related health problems. More information is available at http://www.ndep.nih.gov/ddi.

SEARCH for Diabetes in Youth—Rising rates of diabetes among youths are a growing public health concern. The Centers for Disease Control and Prevention and the National Institutes of Health are funding this 5-year, multicenter study to examine the status of diabetes among U.S. children and adolescents. More information is available at http://www.searchfordiabetes.org/index.cfm.

The U.S. Preventive Services Task Force (USPSTF)—This Task Force was convened by the U.S. Public Health Service to conduct comprehensive reviews of clinical research to assess the merits of preventive measures, including screening tests, counseling, immunizations, and chemoprevention. The Task Force comprises an independent panel of primary care and prevention experts from the private sector. To date, USPSTF has conducted reviews of evidence related to screening for type 2 diabetes and gestational diabetes, obesity in adults, and counseling for physical activity and healthy diet. http://www.ahrq.gov/clinic/uspstfix.htm

Healthy Aging Initiative—A joint project by the Administration on Aging and the Centers for Disease Control and Prevention in which grants are awarded to states to implement evidence-based disease prevention programs at the community level. There are fourteen collaborative projects with State Units on Aging and State Health Departments, including one project focused on diabetes screening, 7 projects focused on physical activity, and three projects focusing on assisting older Americans with disease self-management.

The availability of high-quality diabetes care services is crucial to support persons with diabetes in their efforts to manage the disease and prevent complications. Agencies within HHS support a variety of programs intended to measure and inform the quality of diabetes care in the United States.

National Healthcare Quality and Disparities Reports—These congressionally mandated annual reports on health care quality and health disparities in the United States include a broad set of performance measures that will be used to monitor the nation’s progress toward improved health care quality. Each of these reports contains measures that specifically address diabetes care. More information is available at http://www.qualitymeasures.ahrq.gov.

The National Quality Measures Clearinghouse™ (NQMC™),— Sponsored by HHS’s Agency for Healthcare Research and Quality (AHRQ), The National Quality Measures Clearinghouse (NQMC) is a database and Web site for information on specific evidencebased health care quality measures and measure sets. NQMC is sponsored by AHRQ to promote widespread access to quality measures by the health care community and other interested individuals. As of spring 2004, the NQMC contained 23 measures that address diabetes care. More information is available at http://www.ahrq.gov/qual/measurix.htm.

Diabetes Care Quality Improvement: A Resource Guide for State Action— The Agency for Healthcare Research and Quality (AHRQ), in partnership with The Council of State Governments, produced the Diabetes Care Quality Improvement: A Resource Guide for State Action and its companion workbook, to help states assess the quality of diabetes care and develop quality improvement strategies. These tools provide an overview of the factors that affect quality of care for diabetes; present the core elements of health care quality improvement; assist state policymakers in using the data from AHRQ's 2003 National Healthcare Quality Report for planning state-level quality improvement activities; and, provide a variety of best practices and policy approaches that national organizations, the Federal Government, and states have implemented related to diabetes quality improvement. The Diabetes Care Quality Improvement: A Resource Guide for State Action is available online at http://www.ahrq.gov/qual/diabetes/. The companion workbook is available at http://www.ahrq.gov/qual/diabetes/workbk.htm. Printed copies may be ordered by calling 1-800-358-9295 or by sending an e-mail to ahrqpubs@ahrq.gov.

The Community Guide to Preventive Services—The Task Force on Community Preventive Services is a 15-member nonfederal task force supported by the Centers for Disease Control and Prevention (CDC). CDC scientists review the effectiveness of health care interventions for the task force, which then makes recommendations to the public health community and health care delivery organizations. The recommendations generated by the task force are combined to form the Guide to Community Preventive Services, which includes a section on diabetes. To improve the health of people with diabetes, the task force reviewed the evidence of the effectiveness of diabetes disease and case management and self-management education. More information is available at http://www.thecommunityguide.org/diabetes/default.htm.

Health Disparities Collaborative -Diabetes—The Health Resources and Services Administration, Bureau of Primary Health Care in collaboration with the Centers for Disease Control and Prevention, National Institutes of Health, and other partners, including the Institute for Healthcare Improvement are working to improve diabetes care within Federally Funded Health Centers. The purpose of the Health Disparities Collaborative–Diabetes is to improve diabetes care and performance measures through improved health care delivery systems, and to increase access and decrease health disparities among medically underserved populations. The learning from the Diabetes collaborative will be integrated with the Cardiovascular Collaborative for improved primary health care in Federally Funded Health Centers.

In addition, the Diabetes and Diabetes Prevention (see Current Activities—Prevention section) collaboratives are intended to generate and document improved health outcomes for underserved populations and transform clinical practice through models of patient centered care, improvement, and learning; develop infrastructure, expertise, and multidisciplinary leadership to support and drive improved health status; and build strategic partnerships, which have increased access to expertise, computer software, discounted pharmaceuticals and HbA1c tests, laboratory equipment, direct community resources for patients, health education materials, and community-level marketing and educational resources. More information is available at http://www.healthdisparities.net/

Indian Health Service (IHS)—The Indian Health Service (IHS), National Diabetes Program (NDP) promotes collaborative strategies for the prevention of diabetes and its complications in the 12 IHS Service Areas through coordination of a network of 19 Model Diabetes Programs and 13 Area Diabetes Consultants. The NDP also manages the Special Diabetes Program for Indians grant program with 332 grantees in 35 states. In addition, the IHS has developed standards of care that are routinely updated to help provide consistent, quality care to patients with diabetes. More information is available at http://www.ihs.gov/MedicalPrograms/Diabetes/.

Healthy People 2010 (HP2010)—Healthy People 2010 is a set of disease prevention and health promotion objectives for the nation to achieve by 2010. It includes 17 objectives specifically aimed at reducing the disease and economic burden of diabetes and improving the quality of life for all persons who have or are at risk for diabetes. In addition, Centers for Disease Control and Prevention, Division of Diabetes Translation’s National Objectives include measures for tracking the quality of diabetes care received. For example, these programs assess the number of foot exams, eye exams, and annual HbA1c tests conducted.

The Centers for Medicare & Medicaid Services (CMS)—The Centers for Medicare & Medicaid Services (CMS) provides benefits to Medicare beneficiaries for diabetes selfmanagement training, medical nutrition therapy, prescription drugs, and select testing equipment for persons with diabetes. In addition, CMS sponsors the National Diabetes Eye Exam Program that matches Medicare beneficiaries aged 65 and older who have diabetes and have not had a medical eye exam in the past 3 years with a volunteer ophthalmologist in their area to receive a free comprehensive eye exam and up to 1 year of follow-up care for any condition diagnosed at the initial exam. For more information about Medicare coverage of diabetes services, go to http://www.cms.hhs.gov.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)—This Institute of the National Institutes of Health supports basic and clinical research at universities and medical centers throughout the U.S. and at research facilities in Bethesda, Maryland and Phoenix, Arizona. NIDDK research forms the scientific foundation for improvements in diabetes care and for messages delivered via the National Diabetes Education Program. Examples of NIDDK-supported research include the Diabetes Control and Complications Trial and the Diabetes Prevention Program (previously discussed). There are many other ongoing diabetes research efforts. One important effort is Trial Net, an international network of investigators, clinical centers, and core support facilities whose aim is to recruit patients and support studies that will result in an improved understanding of type 1 diabetes disease development and conduct prevention trials (http://www.diabetestrialnet.org). Another is TEDDY (The Environmental Determinants of Diabetes in the Young), which is developing and carrying out research to identify environmental causes of type 1 diabetes in genetically susceptible individuals (http://www.teddystudy.org/). A third is STOPP-T2D (Studies to Treat or Prevent Pediatric Type 2 Diabetes), which is conducting pilot studies for a school-based trial directed at preventing the risk factors for type 2 diabetes in middle school children, and a multicenter clinical trial of optimal treatment for adolescents with type 2 diabetes (http://www.todaystudy.org/). For more information on type 1 and type 2 diabetes research, please visit http://diabetes.niddk.nih.gov/.

The Diabetes Control and Complications Trial (DCCT)— provided evidence that improving control of blood glucose levels delays the onset and progression of eye, kidney, and nerve diseases caused by diabetes. An ongoing epidemiologic follow-up study of this population, Epidemiology of Diabetes Interventions and Complications (EDIC) study, has shown that the effectiveness of a limited period of intensive glycemic control on reducing complications persist 20 years after the study began and become even stronger over time. More information is available at http://diabetes.niddk.nih.gov/dm/pubs/control/index.htm.

National Diabetes Education Program (NDEP)—Helping the Student with Diabetes Succeed: A Guide for School Personnel—This comprehensive guide is designed to empower school personnel, parents, and students to create a safe learning environment and provide equal access to educational opportunities for all children with diabetes. More information is available at http://www.ndep.nih.gov/resources/school.htm.

The Diabetes Research Working Group (DRWG) was established in 1997 to develop a comprehensive plan of recommended future diabetes research initiatives. The group met over the period of one year and generated Conquering Diabetes: A Strategic Plan for the 21st Century (available at http://www.niddk.nih.gov/federal/dwg/dwgmain.htm), which addressed three main topics:

Extraordinary Opportunities in Diabetes Research—rapidly expanding, crosscutting areas in which increased investment or development of new mechanisms will significantly speed research in areas such as genetics of diabetes, autoimmunity and the beta cell, and obesity.

Special Needs for Special Problems—research targeted to specific populations, complications, and methodological approaches.

Be Smart About Your Heart: Control the ABCs of Diabetes—This campaign, developed by the National Diabetes Education Program, encourages people with diabetes to control not only their blood glucose (sugar), but also their blood pressure and cholesterol. More information is available at http://www.ndep.nih.gov/campaigns/BeSmart/BeSmart_index.htm

National Kidney Disease Education Program (NKDEP)—The National Kidney Disease Education Program, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, aims to raise awareness of the seriousness of kidney disease, the importance of testing those at high risk, and the availability of treatment to prevent or slow kidney failure. The NKDEP is designed to close the gap between evidence and practice by educating people at risk and physicians, with the goal of identifying kidney disease in its early, treatable stages. More information on the NKDEP can be found at http://www.nkdep.nih.gov.

National High Blood Pressure Education Program (NHBPEP)—This goal of this program, which is coordinated by the National Heart, Lung, and Blood Institute of the National Institutes of Health, is to reduce death and disability related to high blood ressure through programs of professional, patient, and public education. The NHBPEP is a cooperative effort among professional and voluntary health agencies, state health departments, and many community groups. More information is available at http://www.nhlbi.nih.gov/about/nhbpep.

National Cholesterol Education Program (NCEP)—The goal of the National Cholesterol Education Program is to contribute to reducing illness and death from heart disease in the U.S. by reducing the percent of Americans with high blood cholesterol. The NCEP directs educational efforts targeted at both health professionals and the public. The program aims to raise awareness and understanding about high blood cholesterol as a risk factor for heart disease and the benefits of lowering cholesterol levels as a means of preventing heart disease. More information about this program, which is coordinated by the National Heart, Lung, and Blood Institute of the National Institutes of Health, can be found at http://www.nhlbi.nih.gov/about/ncep/.

National Eye Health Education Program (NEHEP)—The focus of the National Health Education Program is on public and professional education programs that encourage early detection and timely treatment of diabetic eye disease and glaucoma and the appropriate treatment for low vision. This program is coordinated by the National Eye Institute of the National Institutes of Health in partnership with a variety of public and private organizations. More information can be found at http://www.nei.nih.gov/nehep/.

Family Center Support Project—The Centers for Disease Control and Prevention, Division of Diabetes Translation has undertaken a 5-year behavioral research project that will identify and examine nontraditional psychosocial factors regarding diabetes education and the family. These factors include community characteristics, health care reimbursement, family processes, diabetes education, provider-patient characteristics, acculturation or westernization, as well as psychological factors. Previously unrecognized factors include racism, living arrangements, perceptions of safety, and intergenerational coping skills, and their overall impact on psychological well being. More information is available at http://www.cdc.gov/diabetes/projects/family.htm.

Translating Research Into Action for Diabetes (TRIAD)—Translating Research Into Action for Diabetes is a 5-year, six-center prospective study of managed care and diabetes quality of care, costs, and outcomes in the United States. In its third year, this important study is the first and largest multicenter study of diabetes quality of care, quality of life, and factors affecting them. TRIAD is currently developing plans to carry out a detailed assessment of socioeconomic status and how it relates to quality of care and health status with diabetes. Sponsored by Centers for Disease Control and Prevention and National Institute of Diabetes and Digestive and Kidney Diseases, TRIAD’s overall goal is to examine the influence of managed care structure on processes and outcomes of diabetes care. More information is available at http://www.triadstudy.org/.

National Diabetes Laboratory—Since 1997, the Centers for Disease Control and Prevention (CDC) has dedicated $3 million annually to a National Diabetes Laboratory (NDL) to support emerging scientific efforts to help prevent and treat type 1 diabetes. CDC, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, and the National Center for Environmental Health are collaborators on this project. For example, scientists are working to develop and evaluate laboratory technology for improving the measurement of genetic risk factors for type 1 diabetes and its complications, to study autoantibodies of type 1 diabetes, and to develop other projects that will improve the lives of people with type 1 diabetes. For more information, call toll-free 1-877-CDC-DIAB, e-mail diabetes@cdc.gov, or visit CDC’s National Center for Environmental Health’s National Diabetes Laboratory at http://www.cdc.gov/nceh/dls/diabetes.htm.

Administration on Aging—Evidenced-Based Disease Prevention Program: In 2003, the Administration on Aging launched a new grants program and a public/private partnership to increase older people’s access to programs that have proven to be effective in reducing their risk of disease, disability and injury. One of the focus areas, disease selfmanagement, funds community chronic disease efforts, including those for diabetes. For more information, please visit http://www.aoa.gov/prof/evidence/evidence.asp

National Agenda for Public Health Action: A National Public Health Initiative on Diabetes and Women’s Health—This initiative offers recommendations to help health professionals, women and their families, health care systems, worksites, communities, and schools address the burden of diabetes among women. The Centers for Disease Control and Prevention is working with public- and private-sector partners to implement the plan. More information is available at http://www.cdc.gov/diabetes/pubs/action/index.htm.

Take Time to Care About Diabetes—This campaign developed by the Food and Drug Administration, Office of Women’s Health is intended to raise women’s awareness of the seriousness of diabetes and the importance of taking steps to treat the disease to avoid heart and kidney problems, blindness, stroke, or amputation of a lower limb. More information is available at http://www.fda.gov/womens/taketimetocare/diabetes/default.htm.

Survey Disclaimer

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0379. The time required to complete this information collection is estimated to average 5 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.